Quiet time for mechanically ventilated patients in the medical intensive care unit

McAndrew, Natalie S.; Leske, Jane S.; Guttormson, Jill; Kelber, Sheryl T.; Moore, Kaylen M.; Dabrowski, Sylvia

doi:10.1016/j.iccn.2016.01.003

Cited by 13 publications

(48 citation statements)

References 30 publications

(53 reference statements)

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“…During the full-text review of these 194 articles, 157 were excluded. In total 37 studies were included: 21 assessed association between environmental risk factors and delirium 13,19,20,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] , and 16 reported on delirium after an environmental intervention 7,14,15,18,[48][49][50][51][52][53][54][55][56][57][58][59] ( Figure 1).…”

Section: Literature Search Results and Outcomementioning

confidence: 99%

“…Included studies were conducted between 1997 to 2019, in the USA 19,31,37,39,43,46,58,59 , the Netherlands 14, 32,48,50,51 , Japan 38,41,52,53 , France 33,36,57 , Belgium 13,49 , Denmark 15,34 , Italy 42,47 , Sweden 18,20 , Canada 35 , China 45 , India 40 , Israel 30 , Singapore 55 , South Korea 54 , Thailand 56 , Turkey 44 , and the UK 7 . Of these, 31 studies were conducted among critically ill patients while five reviewed general hospital populations 30,35,41,44,54 , and one a geriatric monitoring unit for acute delirium care 55 .…”

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

“…Of these, 31 studies were conducted among critically ill patients while five reviewed general hospital populations 30,35,41,44,54 , and one a geriatric monitoring unit for acute delirium care 55 . Among the 37 reviewed articles, all observational association studies and 12 interventional studies reported delirium incidence, while two interventional studies measured delirium prevalence 18,58 . Delirium severity was assessed in three interventional studies 48,54,55 .…”

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

“…Most studies assessed delirium using the Confusion Assessment Method for the ICU (CAM-ICU) 7,15,18,19,34,36,37,39,40,42,[45][46][47][48]51,[56][57][58][59] ; other identification methods included the validated Dutch CAM-ICU 32 , Confusion Assessment Method (CAM) 41,50,55 , Intensive Care Delirium Screening Checklist (ICDSC) 14, 33,43 , Neelon and Champagne Confusion Scale (NEECHAM) 13,49 , non-validated 52 and validated 53 Japanese NEECHAM, Delirium Observation Screening Scale (DOSS) 50 , behavioral observations based on the Diagnostic and Statistical Manual of Mental Disorders, 3 rd edition (DSM-III) 35 , 3 rd edition-revised (DSM-III-R) 38 , and 4 th Edition (DSM-IV) 20,41,44 , and behavioral observations based on International Classification of Diseases, 9 th Revision, Clinical Modification (ICD-9-CM) criteria 30 . One study used both retrospective chart review and site-specific pre-specified criteria based on new and rapid onset of disturbed consciousness and/or perceptual disturbances 31 .…”

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

“…In total, 16 studies evaluated the effects of a modified environment on delirium prevention or management 7,14,15,18,[48][49][50][51][52][53][54][55][56][57][58][59] ( Table 5-Table 7). Half were randomized control trials (RCT) 18,49,[51][52][53][54]56,57 , while half used different study designs including: before-after 7,14,48,59 , retrospective cohort 15,50 , and prospective cohort 55,58 . Sample sizes varied from 11 to 748.…”

Section: Effect Of Environmental Interventions On Delirium Preventionmentioning

confidence: 99%

See 4 more Smart Citations

The impact of environmental risk factors on delirium and benefits of noise and light modifications: a scoping review

et al. 2020

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Background: To explore existing literature on the association between environmental risk factors and delirium, and to investigate the effectiveness of environmental modifications on prevention or management of delirium. Methods: This is a scoping review of peer-reviewed studies in PubMed and the reference lists of reviewed articles. Observational studies reporting the effect of noise, light, and circadian rhythm on delirium and interventional studies assessing delirium in modified environments were reviewed. Results: 37 studies were included, 21 of which evaluated the impact of environment on delirium and 16 studied possible solutions to mitigate those impacts. Mixed findings of the reviewed studies yielded inconclusive results; a clearly delineated association between high noise levels, abnormal amounts of light exposure, and sleep disruption with delirium could not be established. The environmental interventions targeted reducing noise exposure, improving daytime and mitigating night-time light exposure to follow circadian rhythm, and promoting sleep. The overall evidence supporting effectiveness of environmental interventions was also of a low confidence; however, quiet-time protocols, earplugs, and bright light therapy showed a benefit for prevention or management of delirium. Conclusions: Environmental modifications are non-invasive, risk-free, and low-cost strategies that may be beneficial in preventing and managing delirium, especially when used as part of a multi-component plan. However, given the limited evidence-based conclusions, further high-quality and larger studies focusing on environmental modifications and delirium outcomes are strongly recommended.

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Section: Literature Search Results and Outcomementioning

confidence: 99%

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

Section: Effect Of Environmental Interventions On Delirium Preventionmentioning

confidence: 99%

See 3 more Smart Citations

The impact of environmental risk factors on delirium and benefits of noise and light modifications: a scoping review

et al. 2020

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The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey

Kang

Lee

Cho

et al. 2022

Australian Critical Care

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The Impact of Environmental Risk Factors on Delirium and Benefits of Noise and Light Modifications: A Scoping Review

Hashemighouchani

Cupka

Lipori

et al. 2020

Preprint

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Purpose: To explore existing literature on the association between environmental risk factors with delirium and to investigate the effectiveness of environmental modifications on prevention or management of delirium. Materials and Methods: This is a scoping review of peer-reviewed studies in Pubmed and the reference lists of reviewed articles. Observational studies reporting the effect of noise, light, and circadian rhythm on delirium and interventional studies assessing delirium in modified environments were reviewed. Results: Thirty eight studies were included, of which, 21 evaluated impact of environment on delirium, and 16 studied the interventions. Interventions targeted reducing noise exposure, improving light exposure to follow circadian rhythm, and promoting sleep. Mixed findings of the reviewed studies yielded to inconclusive results; however quiet-time protocols, earplugs, and bright light therapy might benefit prevention, or management of delirium. Results: Thirty seven studies were included, 21 of which evaluated the impact of environment on delirium and 16 studied possible solutions to mitigate those impacts. Mixed findings of the reviewed studies yielded inconclusive results; a clearly delineated association between high noise levels, abnormal amounts of light exposure, and sleep disruption with delirium could not be established. Interventions targeted reducing noise exposure, improving day-time and mitigating night-time light exposure to follow circadian rhythm, and promoting sleep. The overall evidence supporting effectiveness of environmental interventions was also of a low confidence; however, quiet-time protocols, earplugs, and bright light therapy showed a benefit for prevention or management of delirium. Conclusion: Environmental modifications are non-invasive, risk-free, and low-cost strategies that may be beneficial in preventing and managing delirium, especially when used as part of a multi-component plan. However, given the limited evidence-based conclusions, further high-quality and larger studies focusing on environmental modifications and delirium outcomes are strongly recommended.

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Quiet time for mechanically ventilated patients in the medical intensive care unit

Abstract: QT may influence sedation administration and promote patient rest. Future studies are required to further understand the influence of QT on mechanically ventilated patients in the intensive care unit.

Cited by 13 publications

References 30 publications

The impact of environmental risk factors on delirium and benefits of noise and light modifications: a scoping review

The impact of environmental risk factors on delirium and benefits of noise and light modifications: a scoping review

The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey

The Impact of Environmental Risk Factors on Delirium and Benefits of Noise and Light Modifications: A Scoping Review

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